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<br /> <br /> <br />OR <br /> <br />☐ The contractor notes that the equipment on the mount is not in accordance with the sketch and has <br />noted the differences below and provided photo documentation of any alterations. <br /> <br />Comments: <br /> <br /> <br /> <br /> <br />Was the mount modification completed in conjunction with the equipment change / installation? <br /> <br /> ☐ Yes ☐ No <br /> <br />Special Instructions / Validation as required from the MA or Mod Drawings : <br /> <br />Issue: <br />N/A <br /> <br />Response: <br /> <br /> <br /> <br /> <br />Special Instruction Confirmation: <br /> <br />☐ The contractor has read and acknowledges the above special instructions. <br /> <br />Comments: <br /> <br /> <br />Contractor certifies that the climbing facility / safety climb was not damaged prior to starting work: <br /> <br /> ☐ Yes ☐ No <br /> <br />Contractor certifies no new damage created during the current installation: <br /> <br /> ☐ Yes ☐ No <br /> <br />Contractor to certify the condition of the safety climb and verify no damage when leaving the site: <br /> <br /> ☐ Safety Climb in Good Condition ☐ Safety Climb Damaged <br /> <br /> <br /> <br /> <br />2210 3%4 S Ritchey St # <br />WCC018/5/2024